Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$31,168.13

Service Code	MSDRG 260
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$31,168.13

Service Code	MSDRG 262
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$193,360.92

Service Code	MSDRG 217
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$193,360.92

Service Code	MSDRG 216
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$193,360.92

Service Code	MSDRG 218
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$125,762.81

Service Code	MSDRG 220
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$125,762.81

Service Code	MSDRG 219
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$125,762.81

Service Code	MSDRG 221
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

Cardiolipin Ab, IgG DLS

Facility

$462.00

Service Code	HCPCS 86147
Hospital Charge Code	422861475
Hospital Revenue Code	301
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$448.14
Rate for Payer: AlohaCare Medicaid	$231.00
Rate for Payer: AlohaCare Medicare	$194.04
Rate for Payer: Cash Price	$300.30
Rate for Payer: Cash Price	$300.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$425.04
Rate for Payer: Devoted Health Medicare	$194.04
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$194.04
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$392.70
Rate for Payer: Humana Medicare	$194.04
Rate for Payer: Kaiser Permanente Commercial	$415.80
Rate for Payer: Kaiser Permanente Medicaid	$235.62
Rate for Payer: Kaiser Permanente Medicare	$194.04
Rate for Payer: MDX Hawaii PPO	$448.14
Rate for Payer: Ohana Health Plan Medicaid	$194.04
Rate for Payer: Ohana Health Plan Medicare	$194.04
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$194.04
Rate for Payer: University Health Alliance Commercial	$65.75

Cardiolipin Ab, IgG DLS

Facility

$462.00

Service Code	HCPCS 86147
Hospital Charge Code	422861475
Hospital Revenue Code	301
Min. Negotiated Rate	$392.70
Max. Negotiated Rate	$448.14
Rate for Payer: Cash Price	$300.30
Rate for Payer: Health Management Network Commercial	$392.70
Rate for Payer: Kaiser Permanente Commercial	$415.80
Rate for Payer: MDX Hawaii PPO	$448.14

Cardiolipin Ab, IgM DLS

Facility

$462.00

Service Code	HCPCS 86147
Hospital Charge Code	422861475
Hospital Revenue Code	301
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$448.14
Rate for Payer: AlohaCare Medicaid	$231.00
Rate for Payer: AlohaCare Medicare	$194.04
Rate for Payer: Cash Price	$300.30
Rate for Payer: Cash Price	$300.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$425.04
Rate for Payer: Devoted Health Medicare	$194.04
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$194.04
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$392.70
Rate for Payer: Humana Medicare	$194.04
Rate for Payer: Kaiser Permanente Commercial	$415.80
Rate for Payer: Kaiser Permanente Medicaid	$235.62
Rate for Payer: Kaiser Permanente Medicare	$194.04
Rate for Payer: MDX Hawaii PPO	$448.14
Rate for Payer: Ohana Health Plan Medicaid	$194.04
Rate for Payer: Ohana Health Plan Medicare	$194.04
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$194.04
Rate for Payer: University Health Alliance Commercial	$65.75

Cardiolipin Ab, IgM DLS

Facility

$462.00

Service Code	HCPCS 86147
Hospital Charge Code	422861475
Hospital Revenue Code	301
Min. Negotiated Rate	$392.70
Max. Negotiated Rate	$448.14
Rate for Payer: Cash Price	$300.30
Rate for Payer: Health Management Network Commercial	$392.70
Rate for Payer: Kaiser Permanente Commercial	$415.80
Rate for Payer: MDX Hawaii PPO	$448.14

CARDIOVERSION ED

Facility

$1,692.00

Service Code	HCPCS 92960
Hospital Charge Code	317929600
Hospital Revenue Code	480
Min. Negotiated Rate	$1,438.20
Max. Negotiated Rate	$1,641.24
Rate for Payer: Cash Price	$1,099.80
Rate for Payer: Health Management Network Commercial	$1,438.20
Rate for Payer: Kaiser Permanente Commercial	$1,522.80
Rate for Payer: MDX Hawaii PPO	$1,641.24

CARDIOVERSION ED

Facility

$1,692.00

Service Code	HCPCS 92960
Hospital Charge Code	317929600
Hospital Revenue Code	480
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$846.00
Rate for Payer: AlohaCare Medicare	$710.64
Rate for Payer: Cash Price	$1,099.80
Rate for Payer: Cash Price	$1,099.80
Rate for Payer: Cash Price	$1,099.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,556.64
Rate for Payer: Devoted Health Medicare	$710.64
Rate for Payer: Hawaii Medical Service Association Commercial	$976.00
Rate for Payer: Hawaii Medical Service Association Medicare	$710.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,607.40
Rate for Payer: Health Management Network Commercial	$1,438.20
Rate for Payer: Humana Medicare	$710.64
Rate for Payer: Kaiser Permanente Commercial	$1,522.80
Rate for Payer: Kaiser Permanente Medicaid	$862.92
Rate for Payer: Kaiser Permanente Medicare	$710.64
Rate for Payer: MDX Hawaii PPO	$1,641.24
Rate for Payer: Ohana Health Plan Medicaid	$710.64
Rate for Payer: Ohana Health Plan Medicare	$710.64
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$710.64
Rate for Payer: University Health Alliance Commercial	$4,035.20

carisoprodol 250 mg Tab [KMC]

Facility

$13.22

Service Code	NDC 51525590101
Hospital Revenue Code	250
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$12.82
Rate for Payer: AlohaCare Medicaid	$6.61
Rate for Payer: AlohaCare Medicare	$5.55
Rate for Payer: Cash Price	$8.59
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$12.16
Rate for Payer: Devoted Health Medicare	$5.55
Rate for Payer: Hawaii Medical Service Association Medicare	$5.55
Rate for Payer: Hawaii Western Management Group Commercial	$12.56
Rate for Payer: Health Management Network Commercial	$11.24
Rate for Payer: Humana Medicare	$5.55
Rate for Payer: Kaiser Permanente Commercial	$11.90
Rate for Payer: Kaiser Permanente Medicaid	$6.74
Rate for Payer: Kaiser Permanente Medicare	$5.55
Rate for Payer: MDX Hawaii PPO	$12.82
Rate for Payer: Ohana Health Plan Medicaid	$5.55
Rate for Payer: Ohana Health Plan Medicare	$5.55
Rate for Payer: UnitedHealthcare Medicaid	$7.93
Rate for Payer: UnitedHealthcare Medicare	$5.55
Rate for Payer: University Health Alliance Commercial	$9.64

carisoprodol 250 mg Tab [KMC]

Facility

$13.22

Service Code	NDC 51525590101
Hospital Revenue Code	250
Min. Negotiated Rate	$11.24
Max. Negotiated Rate	$12.82
Rate for Payer: Cash Price	$8.59
Rate for Payer: Health Management Network Commercial	$11.24
Rate for Payer: Kaiser Permanente Commercial	$11.90
Rate for Payer: MDX Hawaii PPO	$12.82

carisoprodol 350 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 50228010901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

carisoprodol 350 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 50228010901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$10,400.00

Service Code	MSDRG 035
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$10,400.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$10,400.00

Service Code	MSDRG 034
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$10,400.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$10,400.00

Service Code	MSDRG 036
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$10,400.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

CARRY CURRENT STATUS

Professional

Both

$0.01

Service Code	HCPCS G8984
Hospital Revenue Code	420
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

CARRY D/C STATUS

Professional

Both

$0.01

Service Code	HCPCS G8986
Hospital Revenue Code	420
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

CARRY GOAL STATUS

Professional

Both

$0.01

Service Code	HCPCS G8985
Hospital Revenue Code	420
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

carvedilol 12.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00904730761
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

Know your out-of-pocket cost for care.

All Charges